Provider Demographics
NPI:1811750565
Name:CSL AUTUMN GLEN LLC
Entity type:Organization
Organization Name:CSL AUTUMN GLEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-308-8338
Mailing Address - Street 1:14755 PRESTON RD STE 810
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6815
Mailing Address - Country:US
Mailing Address - Phone:972-770-5600
Mailing Address - Fax:
Practice Address - Street 1:98 N 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-7512
Practice Address - Country:US
Practice Address - Phone:765-653-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility